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目的糖尿病和高血压都是卒中的强预测因子,然而两者对卒中严重程度是否存在交互作用仍不明确。文中通过流行病学交互作用的研究方法,探讨糖尿病、高血压及其交互作用对卒中严重程度的影响。方法回顾性分析南京卒中注册系统2013年1月至2015年6月期间于南京军区南京总医院神经内科住院的缺血性卒中患者886例。卒中严重程度评价采用国立卫生院神经功能评分(National Institute of Health Stroke Scale,NIHSS),NIHSS<10分为轻/中型卒中,而NIHSS≥10为重型卒中。采用logistic回归分析影响卒中严重程度的因素,糖尿病和高血压交互作用分析采用相加尺度和相乘尺度。最后按患者年龄、性别分层分析糖尿病、高血压的交互作用。结果重型卒中患者260例,占29.3%。多变量logistic回归调整年龄、性别后,糖尿病(OR=1.707,95%CI:1.267~2.300)、高血压(OR=1.603,95%CI:1.111~2.312)增加了重型卒中的危险性。糖尿病、高血压之间存在协同的相加交互作用[相对超危险度比(the relative excess risk due to interaction,RERI)=1.001,95%CI:0.099~1.903],但不存在相乘交互作用(χ~2=1.700,P_(multiplicative)=0.192)。在男性患者中,糖尿病、高血压相乘交互作用(P_(multiplicative)=0.015)和相加交互作用(RERI=1.82,95%CI:0.72~2.92)均有统计学意义。结论糖尿病、高血压可能存在交互作用使重型卒中风险显著增加。改善血糖、血压的控制可能会协同参与阻止卒中的发展。
Diabetes mellitus and hypertension are both strong predictors of stroke, but it is unclear whether there is any interaction between the severity of stroke and stroke. In this paper, the impact of diabetes, hypertension and their interaction on the severity of stroke is explored through the research methods of epidemiological interaction. Methods A retrospective analysis of 886 ischemic stroke patients hospitalized in the Nanjing Stroke Hospital of Nanjing Military Region from January 2013 to June 2015 in Nanjing Stroke Registration System was retrospectively analyzed. Stroke severity was assessed using the National Institute of Health Stroke Scale (NIHSS) with NIHSS <10 for light / moderate stroke and NIHSS> 10 for heavy stroke. Logistic regression analysis was used to analyze the factors influencing the severity of stroke. The interaction between diabetes mellitus and hypertension was analyzed using additive and multiplicative scales. Finally, according to the patient’s age, gender stratification analysis of diabetes, hypertension interaction. Results There were 260 cases of severe stroke, accounting for 29.3%. Multivariable logistic regression showed that the risk of severe stroke was increased after adjustment for age and gender by diabetes mellitus (OR = 1.707, 95% CI: 1.267-2.300) and hypertension (OR = 1.603, 95% CI: 1.111-2.312). There is a synergistic additive interaction between diabetes and hypertension (RERI = 1.001, 95% CI: 0.099-1.903), but there is no reciprocal interaction ( χ ~ 2 = 1.700, multiplicative = 0.192). In male patients, there was a statistically significant association between diabetes and hypertension (multiplicativeness = 0.015) and additive interaction (RERI = 1.82, 95% CI: 0.72-2.92). Conclusion The possible interaction of diabetes mellitus and hypertension may increase the risk of heavy stroke significantly. Improve blood sugar, blood pressure control may be synergistically involved in preventing the development of stroke.